الفهرس 
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Abstract
Over the past three decades, joint replacement surgeries have been increasingly performed throughout the United States and around the world. Specifically, the total volume of total knee replacement increased by 154% between 1993 and 2011.
Local anesthesia, specifically peripheral nerve anesthesia, has been the cornerstone of most multimodal analgesic protocols. Local anesthesia has witnessed significant developments over the past decade while proving effective and superior to other traditional techniques.
Recently, the use of ultrasound guidance has become more popular, improving many nerve block techniques and increasing their utility. Numerous publications have documented progress with respect to increased safety, use of lower amounts of local anesthetic, decreased disease onset times, and prolonged duration of blockade. Furthermore, imaging technology and other necessary resources such as needles, catheters or infusion pumps have been improved in terms of their design and materials used.
Different methods of performing peripheral nerve block for postoperative pain control in patients undergoing total knee arthroplasty have been described in previous studies. These techniques include lumbar plexus anesthesia, femoral nerve anesthesia, with or without sciatic nerve anesthesia, and more recently adductor canal anesthesia.
Femoral nerve anesthesia is a commonly used method for postoperative pain relief. It is considered by some to be the gold standard or cornerstone of postoperative analgesia. However, femoral nerve anesthesia reduces the strength of the quadriceps muscles that are necessary for effective mobilization and contribution to any physical rehabilitation program. Quadriceps weakness puts patients at risk for falls, which may compromise postoperative recovery.
Studies have shown that quadriceps strength is relatively preserved when adductor canal block is compared with femoral nerve anesthesia both in healthy volunteers and in patients undergoing total knee replacement.
Aim of the study:
The aim of this study was to evaluate the effectiveness of the addition of dexamethasone as an adjunct to local anesthetic in adductor canal block compared with periarticular infiltration on mobility and functional improvement in patients with knee osteoarthritis after total knee arthroplasty.
Patients and research methods:
This randomized study was conducted on 120 patients at Assiut University Hospitals from January 2021 to December 2022 after approval by the Scientific Research Ethics Committee.
Patients were divided into two groups:
• group 1: 60 patients: each will receive US-guided adductor canal block with 30 mL of 0.25% bupivacaine plus 1:400,000 epinephrine and 4 mg dexamethasone.
• The second group: included 60 patients: each one will receive 150 ml of 0.25% bupivacaine with 1:400,000 epinephrine, 30 mg of ketorolac, and 8 mg of dexamethasone. Each of them will receive a periarticular infiltrate during the procedure.
Summary of our findings:
• There was a statistically significant difference in the resting pain intensity scale between the adductor canal block and periarticular infiltration groups; At 4 hours postoperatively 2.27 ± 0.45 vs. 2.76 ± 0.44, respectively, p-value (p=0.000), at 12 hours postoperatively 3.36 ± 0.48 vs. 3.67 ± 0.58, respectively, p-value (p=0.026). and 48 hours postoperatively 4.84 ± 0.52 versus 5.48 ± 0.51, respectively, p-value (p=0.000).
• In the adductor canal block group, the measure of pain intensity upon movement was statistically significant lower at all measured time intervals, i.e. at 6 hours it was 3.29 ± 0.46 while in the periarticular infiltration group it was 3.90 ± 0.44 value (b = 0.000), and at 12 An hour was 3.80 ± 0.55, while in the periarticular effusion group it was 4.33 ± 0.66 (b value = 0.001), and at 18 hours it was 4.49 ± 0.51, while in the periarticular effusion group it was 5.00 ± 0.77 (b value = 0.002), at 24 hours. It was 5.31±0.47, while in the periarticular infiltration group it was 5.71±0.90 value (p=0.019).
• There was a statistically significant difference between the two groups, as in the adductor canal block group the time to require the first analgesic was 11.07±1.52 hours, while in the periarticular infiltration group it was 9.95±2.11 values (p=0.020).
• Total rescue analgesic consumption of ketorolac in mg was significantly lower in the adductor canal block group compared to the periarticular infiltration group, 39.07±15 versus 52.50±19.16 mg of ketorolac respectively (p=0.005).